Region III Championship Judging Request Form
Region III
Name Last
First
Address:
City:
State:
Zip:
Region:
1
2
3
4
5
6
7
8
9
Phone:
Other Phone:
Contact Email:
Number of years as a Judge:
How many Regional Championships have you judged:
Current Judges Rating:
Pro #
Safety cert.
Safety
Exp. Date
JO Meets Judged this Season & Dates
Event Judged
1)
2)
3)
4)
5)
6)
If chosen, preferred mode of travel to this year's Regional Championships.
If flying, nearest usable airport to depart.
When you have completed the form, please print and return it to the Regional Chairman. His fax number is 512-452-7875 or email the form to
gilgym@aol.com